Hi Kendall

You asked for feedback re the situation in South Africa.  It appears
that national policy is to focus on AIDS awareness and prevention, thus
preventing women from becoming HIV positive in the first place.  The
Government cannot afford to make AZT available to HIV +ve pregnant women
or their children.  But, apparently Groote Schuur Hospital (the tertiary
institution which has satellite primary-care facilities, such as the
Midwife Obstetric Unit in Khayelitsha) has funding to go ahead with
their research - they prefer to call it a "trial programme". (Based on a
study in Thailand.)  It will start on 4 January 1999.
All pregnant women will receive group education re the programme.  If
they decide to join, their blood will be tested (with counselling).  If
positive, and they join the programme, they will be told not to
breastfeed.  They will be given AZT (300mg bd) from 36 weeks up to and
including delivery.  The babies will be given free formula for 6 months
and Bactrim (antibiotic) from 6 weeks to 15 months.  50% of the cost of
this programme will be the purchase of formula.  Based on Dr Gray's
study in Soweto, the feeling is that an increase in diarrhoea due to
lack of breastfeeding will not be an issue!!
Speaking to nurses and Community Health Workers in Khayelitsha
yesterday, they expressed many of the concerns already discussed on this
list - mainly, that not all mothers have easy access to water.  The
issue of true informed consent and confidentiality of test results is of
great concern.  Also, it seems that the community has not yet been
consulted re this programme!
If this programme is successful, it will be "rolled out' to other areas.

Jean Ridler  RN RM IBCLC (private practice)
Sunny Cape Town
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